FISSURE SEALANTS What are they?

A fissure sealant is a preventive and therapeutic treatment consisting of a low viscosity material which flows into a pre-treated pit or fissure on posterior occlusal surfaces and fills the fissure. They effectively smooth out the occlusal tooth surface, and act as a physical barrier between the tooth and the bacteria in the oral cavity preventing plaque accumulation.
Why do we use them? Pit and fissure caries make up 84% of caries in 5-17 year olds Plaque in stagnant areas Mechanical plaque removal is difficult Depth of the fissure is in close proximity to the EDJ Long term studies have shown around a 50% reduction in decay in sealed teeth compared with controls Acid Etching - Allows bonding by increasing porosity of enamel using 37% phosphoric acid - Improves retention by cleaning the area, removes smear layer, improving wetting ability of the enamel, increasing the SA and forming spaces that the sealant can penetrate into to form tags. - Prefer use of acid gels more control during application - Self-etching adhesive used for younger children but it is not as effective binding to enamel Etched area appears matt, frosty and white upon drying When do we use them? When patient cannot or will not remove plaque from sites of deposit During tooth eruption The occlusal surface is lower than the rest of the teeth in the arch and could be missed by the toothbrush First two permanent molars erupt at 6 and 12 years - the child may not be manually dextrous or motivated enough to clean their teeth effectively Molars are at the back of arch and therefore are less accessible to the brush in a small jaw Molars take 6 months 3 years to fully erupt while some wisdom teeth never fully erupt Fissures with white spot lesions Patients with high caries risk Evidence of previous caries or extractions Fissure morphology deep pits and fissures Medical Mentally/Physically disabled Medical conditions that put children at risk from the consequences following dental diseases Diet High fermentable carbohydrate intake

General Procedure (Resins) 1. Application of local anaesthetic (infiltration or topical) and attach rubber dam 2. Clean tooth surface with pumice & water slurry. Wash away with 3in1 3. Acid etch whole occlusal surface for 15-20s 4. Wash with 3 in 1 and dry surface with air 20-30s until surface looks matt and white 5. Apply sealant with small applicator or syringe chemically-cure or light-cure 6. Once set, wash with pumice & water slurry - Concerns over toxicity of Bisphenol A in unpolymerised resin on the surface (due to inhibition by atmospheric O2) 7. Remove rubber dam and check occlusion with articulating paper

Failure of Fissure sealants - Poor Isolation during application If saliva is allowed to block the pores created by etching, the bond will be weaker. If sealant is partially retained microleakage caries development under sealant - Occlusal parafunctional habits (wear of the sealant) - Patient behavioural problems - Age of patient - Enamel structural defects (amelogenesis imperfecta, dentinogenesis imperfecta)

Types of Sealant The most commercially used are RESINS: - A fissure sealed tooth is not immune to caries but it can have a very good - Chemistry between the sealant resins and composite resins is very similar. protective effect. It should therefore be reviewed by the dentist and The main difference is that the sealant resin is more fluid; checked at every visit and is not an excuse to relax oral hygiene practices! enabling better penetration of fissures. - Examples bis-GMA, UDMA Can have a combination of the two base resins with added filler particles/fumed silica/silanated inorganic glasses creates more viscous resin with desired properties - Light activated polymerisation one component systems (no mixing) applied using syringe activated by a diketone in the presence of an organic or aliphatic amine in visible light free radical addition reaction to give a cross linked polymer outer surface layer of the sealant does not polymerise due to presence of O 2 - Retention of the sealant in the fissure is the result of mechanical bonding caused by penetration of the sealant into the fissure and the etched areas of the enamel forming tags - Poor bonding in presence of saliva (therefore the use of rubber dam is required for good isolation) - Appear translucent or opaque - More recently - sealants that change colour during polymerisation have been introduced e.g. Clinpro. Sealant is pink in colour and when applied converts to a white opaque mass after light curing GLASS IONOMER CEMENTS: - Leach fluoride and provide some caries protection on tooth surfaces at risk - Thicker and do not flow well into narrow or deep pits and fissures - Bond to enamel via ionic bond between the calcium in the enamel and GI - Low retention - more brittle and prone to occlusal wear (more temporary than resin sealants) - Less affected by contamination by saliva (technique insensitivity) - Choice material for erupting tooth FLOWABLE COMPOSITE SEALANTS: Low viscosity composites good verified retention and caries resistance (long term effects are not currently known)